Provider Demographics
NPI:1215124672
Name:FACIAL PAIN AND SLEEP CENTER PLC
Entity type:Organization
Organization Name:FACIAL PAIN AND SLEEP CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHABI
Authorized Official - Middle Name:A
Authorized Official - Last Name:KASPO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-519-1100
Mailing Address - Street 1:3144 JOHN R RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-519-1100
Mailing Address - Fax:
Practice Address - Street 1:3144 JOHN R RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-519-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1915636352OtherBCBSM
MI5803510001Medicare NSC
MI1915636352OtherBCBSM